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general advice to be given to preexisting<br />
patients and their caregivers<br />
in the community:<br />
1. Patients should not stop any current<br />
psychotropic medications without<br />
consulting a doctor<br />
2. In case of poor insight, mental<br />
disorders with intellectual disability,<br />
caregivers must ensure compliance<br />
with adequate supervision<br />
3. If patients are not able to<br />
understand or follow instructions,<br />
caregivers should try and ensure<br />
safety measures like masks, hand<br />
sanitization and physical distancing<br />
4. In case of any new onset psychiatric<br />
symptom, to consult hospital<br />
(preferably teleconsultation)<br />
5. Encourage utilization of teleconsultations<br />
for routine follow-up<br />
and avoid visits to hospital, unless<br />
there is an acute emergency<br />
6. The physician who is treating a<br />
person with mental illness for COVID<br />
19, needs to be informed about the<br />
psychiatric treatment the person is<br />
receiving<br />
Protecting persons with<br />
mental illness in mental health<br />
establishments from COVID 19<br />
infection<br />
Reorganization of Infrastructure and<br />
Administration: General Considerations:<br />
• All MHEs need to constitute a<br />
Hospital Infection Committee that<br />
ensures the implementation of the<br />
newer norms recommended by<br />
the MoHFW during the COVID 19<br />
Pandemic at their establishments,<br />
so as to safely practice mental<br />
health services.<br />
• It is important to ensure adequate<br />
human resources and other<br />
resources (including testing facilities<br />
and equipment like thermometers<br />
or pulse oximeters) for following<br />
the precautionary measures. A<br />
prudent roster/duty system needs<br />
to be developed for health care<br />
workers (including Group D staff)<br />
and adequate stock of masks, hand<br />
sanitizers, face shields, gloves, PPE<br />
kits, etc) need to be made available<br />
for use as appropriate.<br />
• All personnel need to be trained on<br />
hand hygiene, physical distancing,<br />
donning and doffing of the complete<br />
PPE kit.<br />
• Disinfection and waste management:<br />
o Disinfection of equipment and<br />
surfaces that patients come in<br />
contact with (include stethoscope,<br />
blood pressure cuffs, stretchers<br />
and examination couch)need be<br />
disinfected after every use with<br />
1% sodium hypochlorite solution<br />
or alcohol (70% alcohol based)<br />
solution.<br />
o Other surfaces which are<br />
frequently touched such as<br />
doorknobs, waiting areas, chairs<br />
used by patients and table<br />
surfaces in the outpatient or clinic<br />
have to be disinfected frequently<br />
(recommended at least once in 4<br />
hours))<br />
o All the locations for patients<br />
care (inpatient, outpatient,<br />
emergency) have to be<br />
disinfected mandatorily at the end<br />
of the day.<br />
o The bio-medical waste<br />
generated such as the PPE has to<br />
be disposed in yellow bags, the<br />
inside of which is sprayed with 1%<br />
sodium hypochlorite solution. The<br />
exterior of the bag also needs to<br />
be sprayed after tying. This must<br />
be disposed as per the hospital<br />
biomedical waste management<br />
protocols. Hand sanitization must<br />
be followed after disposal.<br />
• IEC materials such as symptoms of<br />
COVID-19, hand hygiene techniques,<br />
precautions to be taken to prevent<br />
the spread of COVID-19 have to be<br />
on displayed at prominent areas in all<br />
the patient care locations (eg. in the<br />
waiting halls of OPD, etc.)<br />
Outpatient Facility:<br />
• Encourage only appointmentbased<br />
OPD consultations to prevent<br />
crowding<br />
• Make seating arrangements at<br />
the waiting hall ensuring physical<br />
distancing norms.<br />
• Designate separate areas for patients<br />
screened positive and negative for ILI<br />
symptoms.<br />
• Have dedicated entry and exit points<br />
separately for patients and health<br />
care workers.<br />
• Ensure adequate ventilation is<br />
available in the building especially in<br />
the waiting hall and doctor’s chamber<br />
or outpatient examination rooms.<br />
• Use of air-conditioning must be<br />
strictly avoided.<br />
• For patients with ILI symptoms,<br />
arrange a separate area for<br />
examination by medical staff using<br />
appropriate protective equipment.<br />
After consultation, the patient if<br />
Covid-positive should be referred<br />
to a COVID centre for further<br />
management.<br />
• Referring patients to nearby DMHP<br />
hospital should be encouraged<br />
alongside teleconsultations follow ups<br />
for reducing the footfalls.<br />
• In addition, provision for<br />
telemedicine/tele-psychiatry services<br />
shall be utilized for reducing the<br />
footfalls further<br />
Inpatient Facility:<br />
• Provision for dedicated area for<br />
donning and doffing of PPE and swab<br />
collection.<br />
• Quarantine and isolation facilities<br />
for patients and staff to be made<br />
available separately in case of<br />
suspected COVID and COVID positive<br />
cases, respectively.<br />
• Wards providing single rooms<br />
with all facilities should encourage<br />
patients to remain inside their rooms<br />
as much as possible. Though this<br />
is contrary to the normal running<br />
of ward, staff should find ways to<br />
monitor the patients inside the ward.<br />
Rules and restrictions can be revised<br />
appropriately, viz., eating while<br />
watching television.<br />
• Wards providing single rooms<br />
without toilet or shower facilities<br />
should plan proactively to manage<br />
personal hygiene. This may include<br />
90 / FUTURE MEDICINE / <strong>December</strong> <strong>2020</strong>
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